Sunday, November 10, 2013

Ministry reviewing entry qualifications

THE Health Ministry is looking into the possibility of increasing the minimum entry qualifications into medical colleges in a move to improve the standard of healthcare in the country and the competency of doctors.

The ministry, together with the Ministry of Education, has embarked on a study to review the existing entry requirements.

According to the Malaysian Medical Council website, the minimum entry requirement into medical school currently is five Bs at SPM level in biology, physics, chemistry, mathematics or additional mathematics and another subject.

"We're investigating whether the minimum qualification needs to be re-looked. Nursing colleges started with three credits which was later increased to five.

"Similarly, we are looking at this possible scenario for those applying to medical colleges," said the ministry's deputy director-general of health (medical) Datuk Dr Jeyaindran Sinnadurai.

On claims that many junior doctors are not as competent or passionate about their job because of insufficient training, he admitted this was partly true.

"We have had several meetings to address the training of house officers (HOs). For example, their training used to run for 12 months, but now it has been extended to 24 months."

He said this was because those trained overseas did not have similar exposure to patients, as local graduates did. Hence, it was necessary for them to relearn various aspects of all the six mandatory disciplines in medicine.

"Many are very stressed out because they have not been exposed to this type of clinical practice in their medical schools and it comes as a culture shock."

He also said the flexi-system introduced some time ago for house officers had some limitations in that it did not give the HOs ownership and accountability for their patients.

"To overcome this we have made several modifications and are confident that it will address these areas of concern.

"With our proposed new system, we're certain that HOs will have adequate supervision to ensure they take ownership of their patient and be accountable for their management. This will result in them working 65 to 75 hours a week, which we think is acceptable," he added.

To ensure adequate exposure to clinical procedures and other ward-based work, the ministry is working on implementing a one HO to four patients ratio.

Dr Jeyaindran said that when he was a HO in the early 1980s, it used to be a 1:20 patients ratio. While the original ministry quota was 1:14, today it's 1:3 patients. Other countries, such as Singapore have a ratio of 1:8 while in the United Kingdom it is 1:12.

"Still, some HOs are complaining about too much work and too many hours. It was recently brought up that HOs shouldn't work more than 60 hours a week.

"However, they should consider their housemanship as a period of training, not focusing on how many hours they worked but the amount of experience that was gained."

He said of the 144 government hospitals, 48 are designated as training hospitals for HOs, with close to 35,000 beds.

The ministry is hoping to open two more training hospitals soon.

"Over and above this, as non-communicable diseases (NCD) are beginning to be a burden to the healthcare system, we're looking at HOs to be trained at primary care clinics (klinik kesihatan) under the supervision of family physicians.

"This pilot project will start early next year. We need to realign the training of our future doctors based on changing needs of the nation and evolving disease patterns."

Dr Jeyaindran, however, does not foresee medical graduates becoming jobless in the near future, despite the fears expressed by the MMA.

"Admittedly there will come a time when they will have to wait a while to find suitable training posts. They will not get a vacancy straight away. They'll have to apply and wait their turn. It's a worldwide phenomenon.

"It's not a minibus, you can't shove in as many people at one time as you like. And, when a graduate applies to the government, he or she has to go through the process; it's not about not having enough posts."

He said the ministry was also studying the current status of medical colleges, particularly the number of students admitted per year.

"There are close to 360 medical colleges all over the world. Locally, we are producing about 4,000 medical graduates annually.

"This does not include the 2,000 to 3,000 who come back every year. But we don't really know the numbers because many are privately funded, mostly by their parents.

"The study has already been mooted and the outcome will be out next year."

On accusations that there aren't sufficient postings for HOs, Dr Jeyaindran said there was enough capacity.

"We have 9,500 medical postings and 10,000 available medical posts, so there is capacity.

"When we re-look the numbers, 9,000 might be the optimal figure but we are changing gradually, it must be a progressive move.

"How fast we do it will depend on the outcome of the two studies.

"The data will help us make rational decisions. We have to ask ourselves what is a safe number to attain in delivering safe healthcare; it's a numbers game.

"We are getting there but it may take a longer time."

He added that as of now, there were no plans to reduce the duration of HO training.

"We are still maintaining the need for HOs to undergo two years of housemanship and two years of compulsory service.

"If you come from an unrecognised college, you must sit for a compulsory exam. Unfortunately, it was decided that this medical qualifying exam can be taken almost anywhere.

"Before, it was only available in Universiti Sains Malaysia (USM), Universiti Malaya (UM) and Universiti Kebangsaan Malaysia (UKM).

"MMC strongly feels that the standard should be the same.

"Although we have many local colleges, the final assessment is very different from university to university.

"Building two, three or four more hospitals is not the solution, and MMA's suggestion to have training hospitals for medical colleges is not the answer either.

"We must have specialists of sufficient seniority; we want to get it right the first time and not make hasty decisions."